Last week’s article about pain produced one of the biggest responses to anything I’ve written thus far so I thought I’d expand a bit more on the subject of pain – because there’s nothing like milking it when you do something popular at school….

Just before we get into it, two things: One: I’m not trying to write the definitive article on pain here – I’m just summarising the various results of my research, discussions and outcomes from sessions which I have found interesting or helpful.

Secondly: As I said from the beginning – I started writing this stuff as part of my effort to be more proactive in managing my mental health. However, if it helps just one person, then I am delighted beyond all measure.

Let’s address last week’s thunderbolt: Pain is just a construct of the brain.

We assume that we feel pain in the area of the body that actually hurts – but that is not the case. Pain only exists in the brain. If I cut my little finger, it is not my little finger that experiences pain – it is my brain which interprets signals sent to it.

Let’s examine that. A friend of mine once broke his wrist while cooking – a large pan of boiling water fell on his wrist and very painfully broke three bones. All the way to the hospital, he agonised with the pain in his wrist where the pan had dropped on it and even an untrained observer could see it was very badly swollen from the impact.

At the hospital, they examined his wrist before carting him off to x-ray. It was only in the x-ray room that he started to feel other discomfort and complained of a burning sensation on his foot. On further examination, he was found to have some painful but not too severe burns to his feet.

If we sensed pain in the soft tissue/ nerves area of an injury, his foot would have hurt immediately just as his wrist had. Why did it not? Because the brain recognised that the injury to his wrist took precedence and therefore sent out the pain signal to his wrist. Why? Because pain is simply a construct of the brain.

Still not with me? OK – how often have you cut yourself but not realised immediately? If pain was a product of the nerves and fibres around the body, then we would sense that cut immediately. As another example, how often do we read (or for some unfortunate souls, experience) the concept of phantom pain in an amputated limb? We can’t possibly feel pain in a body part that we no longer possess – unless pain is simply a construct of the brain.

Not long ago, I was doing some gardening (which resulted in the growth of a large variety of weeds but very few tomatoes or flowers) and I cut my finger. I didn’t notice until the blood started dripping down onto the trowel. To that point, I hadn’t felt any pain or discomfort, But as soon as I saw that blood, I was in so much pain that I seriously considered amputation by secateurs (which would probably have been my most effective bit of pruning all day). Again, if pain were a product of the peripheral nervous system (arms and legs, basically) or even the central nervous system (everything else), we would feel pain immediately in the area of where the cut had happened.

So what happens when we feel pain? Let’s assume I’m going to the loo during the night (an event that seems to be far more frequent than seems strictly necessary in recent years) and I stub my toe on the bed. Immediately the nerves in my toe, or the soft tissue surrounding it, send a message up to the base of my spine (I’ll come back to this) telling me something has just happened to my toe. Nerves are a bit thick and don’t know anything so all they do is send and receive information. The message gets sent to the spinal cord which relays the information up to the brain that something has happened to my toes.

What happens next is quite remarkable. The brain looks at a myriad of different inputs to determine how to respond. These inputs are directly affected by my life experience (because it’s my brain). So it will look at:

• Has this happened before – if so, what did we do last time?
• If it did happen before, does this feel worse, the same or not as bad?
• Visual image – Is it bleeding or misshapen, or does it look exactly the same?
• Fears – Oh no! My leg might fall off?
• Cultural influences: I’m a tough northern lad – we don’t show pain…
• Expectations – It felt like only a little bump so it shouldn’t be too bad
• Fears – It’s entirely likely that that there is a 200 foot tall savage monster emanating from the pits of hell underneath my bed and it is currently trying to eat me alive…and I still need a wee…

This is by no means a definitive list! Even my belief system will play a part in the decision-making process.

Once it has consulted all these influences, it will the make a decision as to whether to send out the pain alert. There are two fascinating things to understand here. One – the brain does not make a diagnosis. It merely sends out a message that says “there is something wrong. We must do something and protect the body”. It’s a bit like Commissioner Gordon sending out the bat signal. He doesn’t know what the solution is but he knows he needs to summon Batman to do his whole ‘ker-pow’ thing. Different brain functions decide what to do next – but this part of the brain simply sends out the bat signal to register pain. So – we may deduce therefore (and I’m looking over my professorial glasses at you now!) that pain’s purpose is to protect the body by informing it that something is wrong.

The second fascinating thing to understand is that the brain only determines that something is wrong – it is the spinal cord which determines the volume (or intensity) of the pain. Curious isn’t it? The brains sends out the signal but it does not regulate its intensity. It’s like the BBC sends out the radio signal, but I decide how loud it is by using the volume control on my radio.

Pain is a feeling – a sensation. Your finger does not understand the difference between touching a soft cotton sheet or the stinging barb of a nettle. It requires the brain to interpret the information through memories, sight and experience. If I say the words “fresh crisp cotton bedsheets” every single one of you reading this (or to be strictly accurate, both of you) will have a sensation and you will know exactly what I am talking about. You aren’t touching the sheets – but you know what they feel like. That’s your brain doing its thing. Another example, if a lady puts on a gold necklace, she will immediately feel the touch of the cold metal on her skin. But that feeling is transitory and brief because the brain decides it is not necessary to continue to produce that sensation while wearing the necklace so the brain simply ignores it (it’s very busy up there you know!).

So our nervous system relays information via the spinal cord to the brain which interprets that information and protects the body by issuing the all-points pain alert. Generally speaking, if the incident occurs in the legs or lower body, the information is transported to the brain via the lumbar region of the spinal cord. If its the arms or upper body, it goes via the neck area of the spinal cord. Once the incident has been dealt with and protective or remedial action has been taken, the pain signal is aborted and the all clear is sounded.

In a nutshell (and apologies to all medical practitioners for the gross over-simplification) that is how our nervous system works.

But for some people, their system is broken and the brain never switches off the pain signal. It is constant and the only variable is the volume switch (which, as we discussed earlier, is controlled by the spinal cord). It is a 24 hour unwelcome live-in lodger. It is a difficult, and in many cases, miserable existence.

Next time, let’s have a chat about what all this means for cancer patients who are also fighting chronic pain syndrome or fibromyalgia. But that’s enough insomnia-cure for one day. In the meantime:

Stay strong. Fight hard. Smile lots.